Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy

Background

The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG).

Methods

A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. These patients were divided into a PG group and a PJ group according to the pancreatic reconstruction. DGE occurrence and its association with intra-abdominal complications was compared between the two types of pancreatic reconstruction.

Results

The overall incidence of DGE was 27.7%. Intra-abdominal complications including pancreatic fistula were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. In addition, DGE with intra-abdominal complications tended to be more frequent in PG, despite the fact that intra-abdominal complications occurred at a similar frequency in both groups.

Conclusions

Intra-abdominal complications were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. We speculate that intra-abdominal complications affected patients with PG more and resulted in frequent occurrence of DGE.

Sex-Specific Alterations of White Matter Developmental Trajectories in Infants With Prenatal Exposure to Methamphetamine and Tobacco

IMPORTANCE

Methamphetamine is a common illicit drug used worldwide. Methamphetamine and/or tobacco use by pregnant women remains prevalent. However, little is known about the effect of comorbid methamphetamine and tobacco use on human fetal brain development.

OBJECTIVE

To investigate whether microstructural brain abnormalities reported in children with prenatal methamphetamine and/or tobacco exposure are present at birth before childhood environmental influences.

DESIGN, SETTING, AND PARTICIPANTS

A prospective, longitudinal study was conducted between September 17, 2008, and February 28, 2015, at an ambulatory academic medical center. A total of 752 infant-mother dyads were screened and 139 of 195 qualified neonates were evaluated (36 methamphetamine/tobacco exposed, 32 tobacco exposed, and 71 unexposed controls). They were recruited consecutively from the community.

EXPOSURES

Prenatal methamphetamine and/or tobacco exposure.

MAIN OUTCOMES AND MEASURES

Quantitative neurologic examination and diffusion tensor imaging performed 1 to 3 times through age 4 months; diffusivities and fractional anisotropy (FA) assessed in 7 white matter tracts and 4 subcortical brain regions using an automated atlas-based method.

RESULTS

Of the 139 infants evaluated, 72 were female (51.8%); the mean (SE) postmenstrual age at baseline was 41.5 (0.27) weeks. Methamphetamine/tobacco-exposed infants showed delayed developmental trajectories on active muscle tone (group × age, P < .001) and total neurologic scores (group × age, P = .01) that normalized by ages 3 to 4 months. Only methamphetamine/tobacco-exposed boys had lower FA (group × age, P = .02) and higher diffusivities in superior (SCR) and posterior corona radiatae (PCR) (group × age × sex, P = .002; group × age × sex, P = .01) at baseline that normalized by age 3 months. Only methamphetamine/tobacco- and tobacco-exposed girls showed persistently lower FA in anterior corona radiata (ACR) (group, P = .04; group × age × sex, P = .01). Tobacco-exposed infants showed persistently lower axial diffusion in the thalamus and internal capsule across groups (P = .02).

CONCLUSIONS AND RELEVANCE

Prenatal methamphetamine/tobacco exposure may lead to delays in motor development, with less coherent fibers and less myelination in SCR and PCR only in male infants, but these abnormalities may normalize by ages 3 to 4 months after cessation of stimulant exposure. In contrast, persistently less coherent ACR fibers were observed in methamphetamine/tobacco- and tobacco-exposed girls, possibly from increased dendritic branching or spine density due to epigenetic influences. Persistently lower diffusivity in the thalamus and internal capsule of all tobacco-exposed infants suggests aberrant axonal development. Collectively, prenatal methamphetamine and/or tobacco exposure may lead to delayed motor development and white matter maturation in sex- and regional-specific manners.

Neural correlates for perception of companion animal photographs

Anthrozoological neuroscience, which we propose as the use of neuroscience techniques to study human-animal interaction, may help to elucidate mechanisms underlying the associated psychological, physiological, and other purported health effects. This preliminary study investigates the neural response to animal photographs in pet owners and non-pet owners, and both attraction and attachment to companion animals as modulators of human perception of companion animal photographs. Thirty male participants, 15 "Pet Owners" (PO) and 15 "Non-Pet Owners" (NPO), viewed photographs of companion animals during functional MRI (fMRI) scans at 3 T and provided ratings of attraction to the animal species represented in the photographs. Fourteen subjects additionally submitted and viewed personal pet photographs during fMRI scans, and completed the Lexington Attachment to Pets Scale (LAPS). PO exhibited greater activation than NPO during the viewing of animal photographs in areas of the insula, and frontal and occipital cortices. Moreover, ratings of attraction to animals correlated positively with neural activation in the cingulate gyrus, precentral gyrus, inferior parietal lobule, and superior temporal gyrus during the viewing of representative photographs. For subjects with household pets, scores on the LAPS correlated positively with neural activation during the viewing of owned pet photographs in the precuneus, cuneus, and superior parietal lobule. Our preliminary findings suggest that human perception of companion animals involve the visual attention network, which may be modulated at the neural level by subjective experiences of attraction or attachment to animals. Our understanding of human-animal interactions through anthrozoological neuroscience may better direct therapeutic applications, such as animal-assisted therapy.

Abstract P1-07-15: The outcomes for super elderly patients over 80 years old after breast cancer surgery

(Purpose)

Considering the dramatic increase in average life expectancy throughout the world, the management of super-elderly patients over 80 years old (SEP) with breast cancer has become a global issue. However, there have been few clinical trials for SEP until now. The reasons for this were a small population, unpredictable prognosis, a large number of non-cancer-related deaths and a lower function of multiple organs in SEP. Surgical treatment or post-operative treatment based on evidence of clinical trials for SEP has also not been unclear. We hypothesized that the outcome of SEP with breast cancer compared with other ages were similarly depended on the breast cancer subtypes.

The aim of this study was to clarify the breast cancer related survival (BRS) rate and overall survival (OS) rate at 5years for SEP according to breast cancer subtype.

(Methods)

We retrospectively analyzed 407 patients over 80 years old at initial operation between April, 1994 and April 2015 from 4 institutions of Chiba Youth Breast Oncology Research Group.

Overall, 366 patients with stage I to Stage IIIc were included.

41 patients with Stage 0 or IV were excluded in this study.

We compared the clinical characteristics, OS and BRS rates among the breast cancer subtype: such as ER positive HER2 negative (ER group), ER negative HER2 negative (TN group), ER negative HER2 positive (HER2 group) and ER positive HER2 positive (ER/HER2 group).

Univariate and multivariate analyses were performed to identify the factors of Tumor size, Lymph node, Ly, ER, HER2 and characteristics, associated with the OS and BRS.

(Results)

The median age of the 366 patients was 83 years (range 80-96 years).The median follow-up duration was 32 months (range, 2-120).

During the follow-up period, 25 (9.4%) patients in the ER group, 19 (27.5%) in TN group, 4 (22.2%) in HER2 group and 2 (20.0%) patients in ER-HER2 group died.

The 5 year OS and BRS rates were 89.2%, 97.1% in ER group, 64.6%, 81.2% in TN group, 61.5%,33.3% in HER2 group and 83.3%, 100% in ER-HER2 group, respectively.

Univariate and multivariate analyses revealed that ER was one prognostic factor to OS and BRS.

ER positive patients treatment with Aromatase inhibitor had significantly longer survival rates than treatment with Tamoxifen or no treatment (p=0.05).

There were no significant differences in OS or BRS of TN patients according to the use of chemotherapy (n=7) versus non treatment (n=61).

(Conclusions)

The prognosis and clinical course of super elderly patients with breast cancer depended on subtype.

Adjuvant therapy for ER group was one prognostic factor to OS and BRS.

Citation Format: Nakamura R, Matsuzaki H, Sakamoto M, Suda K, Hayama S, Sangai T. The outcomes for super elderly patients over 80 years old after breast cancer surgery. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-15.

Delayed early developmental trajectories of white matter tracts of functional pathways in preterm-born infants: Longitudinal diffusion tensor imaging data

Probabilistic maps of white matter pathways related to motor, somatosensory, auditory, visual, and limbic functions, and major white matter tracts (the corpus callosum, the inferior fronto-occipital fasciculus, and the middle cerebellar peduncle) were applied to evaluate the developmental trajectories of these tracts, using longitudinal diffusion tensor imaging (DTI) obtained in term-born and preterm-born healthy infants. Nineteen term-born and 30 preterm-born infants completed MR scans at three time points: Time-point 1, 41.6±2.7 postmenstrual weeks; Time-point 2, 46.0±2.9 postmenstrual weeks; and Time-point 3, 50.8±3.7 postmenstrual weeks. The DTI-derived scalar values (fractional anisotropy, eigenvalues, and radial diffusivity) of the three time points are available in this Data article.

Probabilistic maps of the white matter tracts with known associated functions on the neonatal brain atlas: Application to evaluate longitudinal developmental trajectories in term-born and preterm-born infants

Diffusion tensor imaging (DTI) has been widely used to investigate the development of the neonatal and infant brain, and deviations related to various diseases or medical conditions like preterm birth. In this study, we created a probabilistic map of fiber pathways with known associated functions, on a published neonatal multimodal atlas. The pathways-of-interest include the superficial white matter (SWM) fibers just beneath the specific cytoarchitectonically defined cortical areas, which were difficult to evaluate with existing DTI analysis methods. The Jülich cytoarchitectonic atlas was applied to define cortical areas related to specific brain functions, and the Dynamic Programming (DP) method was applied to delineate the white matter pathways traversing through the SWM. Probabilistic maps were created for pathways related to motor, somatosensory, auditory, visual, and limbic functions, as well as major white matter tracts, such as the corpus callosum, the inferior fronto-occipital fasciculus, and the middle cerebellar peduncle, by delineating these structures in eleven healthy term-born neonates. In order to characterize maturation-related changes in diffusivity measures of these pathways, the probabilistic maps were then applied to DTIs of 49 healthy infants who were longitudinally scanned at three time-points, approximately five weeks apart. First, we investigated the normal developmental pattern based on 19 term-born infants. Next, we analyzed 30 preterm-born infants to identify developmental patterns related to preterm birth. Last, we investigated the difference in diffusion measures between these groups to evaluate the effects of preterm birth on the development of these functional pathways. Term-born and preterm-born infants both demonstrated a time-dependent decrease in diffusivity, indicating postnatal maturation in these pathways, with laterality seen in the corticospinal tract and the optic radiation. The comparison between term- and preterm-born infants indicated higher diffusivity in the preterm-born infants than in the term-born infants in three of these pathways: the body of the corpus callosum; the left inferior longitudinal fasciculus; and the pathway connecting the left primary/secondary visual cortices and the motion-sensitive area in the occipitotemporal visual cortex (V5/MT+). Probabilistic maps provided an opportunity to investigate developmental changes of each white matter pathway. Whether alterations in white matter pathways can predict functional outcomes will be further investigated in a follow-up study.

Prevalence of Salmonella, Yersinia and Campylobacter spp. in feral raccoons (Procyon lotor) and masked palm civets (Paguma larvata) in Japan

To estimate the public and animal health risk that alien species pose, the prevalence of Salmonella, Yersinia, and Campylobacter spp. in feral raccoons (Procyon lotor, n = 459) and masked palm civets (Paguma larvata, n = 153), which are abundant alien species in Japan, was investigated in urban and suburban areas of Japan. Salmonella enterica was detected from 29 samples [26 raccoons, 5.7%, 95% confidence interval (CI) 7.8–3.5%; three masked palm civets, 2.0%, 95% CI 4.2–0%]. Many of the isolates belonged to serovars that are commonly isolated from human gastroenteritis patients (e.g. S. Infantis, S. Typhimurium, and S. Thompson). The antimicrobial susceptibility test showed that 26.9 % of the isolates from raccoons were resistant to at least one antimicrobial agent, whereas none of the isolates from masked palm civets were resistant. Yersinia sp. was detected from 193 samples (177 raccoons, 38.6%, 95% CI 43.0–34.1%; 16 masked palm civets, 10.5%, 95% CI 15.3–5.6%). All virulent Yersinia strains belonged to Yersinia pseudotuberculosis, which was isolated from seven (1.5%, 95% CI 2.6–0.4%) raccoons and six (3.9%, 95% CI 7.0–0.8%) masked palm civets. According to the detection of virulence factors, all the Y. pseudotuberculosis isolates belonged to the Far Eastern systemic pathogenicity type. Campylobacter spp. was detected from 17 samples (six raccoons, 1.3%, 95% CI 2.3–0.3%; 11 masked palm civets, 7.2%, 95% CI 11.3–3.1%). Among these, three isolates from raccoons were identified as C. jejuni. These results showed that these pathogens can be transmitted by human activities, other wild animals, and the environment to feral raccoons and masked palm civets, and vice versa. As these animals have omnivorous behaviour and a wide range of habitats, they can play an important role in the transmission of the enteric pathogens.

Multiple early bronchioloalveolar carcinomas in both lungs

We treated a 49-year-old woman with synchronous multiple bronchioloalveolar carcinomas (BAC). Multiple bilateral 'ground-glass' opacities were detected by computed tomography (CT). We performed partial lung resection, and the pathologic diagnosis was atypical adenomatous hyperplasia. Two and one-half years later, a lesion showed enlargement, and was resected along with some others. The histopathologic diagnosis was multiple early BAC. High-resolution CT is likely to detect increasing numbers of similar cases.

Histologic Changes in Thyroid Glands from Great Cormorant (Phalacrocorax carbo) in Tokyo Bay, Japan: Possible Association with Environmental Contaminants

We compared morphologic changes in thyroid glands of great cormorants (Phalacrocorax carbo) from the Tokyo Bay and Lake Biwa areas in Japan with presence of residues of polychlorinated dibenzo-dioxins (PCDDs), polychlorinated dibenzo-furans (PCDFs), and coplanar polychlorinated biphenyls (Co-PCBs). Prominent morphologic changes in thyroid glands included increased density of small follicles and increased number of epithelial cells surrounding follicular lumens. The extent of morphologic changes in the thyroid gland was higher in cormorants captured from Tokyo Bay than in those captured from Lake Biwa. Increased thyroid change in cormorants from the Tokyo Bay area was associated with significantly higher levels of PCDFs and Co-PCBs. Thus, we suggest that morphologic changes in thyroid glands from the cormorants are associated with increased levels of dioxin contamination in Japan.

Polychlorinated dibenzo-p-dioxins, dibenzofurans, and dioxin-like polychlorinated biphenyls in livers of birds from Japan

Concentrations of 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and non- and mono-ortho-chlorine-substituted polychlorinated biphenyls (dioxin-like PCBs) were measured in livers of 17 species of birds collected from Japan. Birds were grouped according to their feeding habits as granivores, piscivores, omnivores, and predators for discussions. Livers of granivores contained relatively low concentrations of PCDD/DFs (80-660 pg/g) followed in increasing order by omnivores (2,300-8,000 pg/g), piscivores (61-12,000 pg/g) and predators (480-490,000 pg/g on a fat weight basis). Especially, one species of predatory bird (mountain hawk eagle) contained elevated concentrations of PCDDs, PCDFs, and dioxin-like PCBs, and the measured concentration is one of the highest reported to date. Homolog and congener patterns of PCDDs and PCDFs varied among species; hence, the results suggested that feeding habits, specific elimination, and metabolism influence contamination pattern. Concentrations of dioxin-like PCBs were in the order of granivores (32-83 ng/g) < predators [excluding mountain hawk eagle] (32-2,500 ng/g) < piscivore (61-12,000 ng/g) < omnivores (1,800-67,000 ng/g on a fat weight basis). Mountain hawk eagle contained the highest concentration of dioxin-like PCBs (55,000 ng/g fat weight). 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) toxic equivalents (TEQs) ranged from 53-450,000 pg/g fat weight. 23478-PeCDF, 2378-TCDD/TCDF, and PCB congeners IUPAC 126 and 77 were major contributors to TEQs in birds. To our knowledge, this is the first study of PCDD/DFs and dioxin-like PCBs in livers of several species of Japanese birds.

Chlorinated persistent organic pollutants in black-tailed gulls (Larus crassirostris) from Hokkaido, Japan

Concentrations and patterns of several chlorinated persistent organic pollutants (POPs) including polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs) and biphenyls (PCBs) and DDTs, HCHs, CHLs and HCB were determined in black-tailed gulls (Larus crassirostris) from breeding grounds in Hokkaido, Japan. Subcutaneous fat of five adult gulls was analyzed, which had different concentrations of target compounds, whereas gull eggs contained similar concentrations of target compounds. Similar congener profiles were found between adult gulls and eggs. The concentrations of non-ortho PCBs varied from 3.4 to 13.5 ng/g lipid weight (lw) in the fat of black-tailed gulls and from 2.4 to 7.4 ng/g lw in their eggs. 2,3,7,8-PCDD/Fs occurred at relatively lower concentrations than non-ortho PCB congeners in both adult gulls and eggs. The total TEQs (toxic equivalents, PCDD/Fs+ non-ortho PCB) ranged from 0.26 to 1.0 ng/g lw in adult gulls and ranged from 0.19 to 0.58 ng/g lw in eggs.

Postcranial skeleton of a macaque trained for bipedal standing and walking and implications for functional adaptation

The postcranial skeleton of a Japanese macaque that had been trained for bipedalism over an 11-year period was studied. Considerable modifications in the hindlimb bones caused by bipedal postural and locomotor behaviour were observed. Changes occurred in joint morphology, articular dimensions and shape-dependent strength of long bones, reflecting the causal relationship between function and morphology. However, the conditions under which the modifications are developed are somewhat different from those in humans, as the monkey's bipedalism is distinct from that of humans. The modifications seem to result from a compromise between functional requirements and the genetically determined anatomy of the essentially quadrupedal monkey.

A case of cleft palate in a Kuril seal (Phoca vitulina stejnegeri), from Hokkaido, Japan

A male pup Kuril seal (Phoca vitulina stejnegeri) from Hokkaido, Japan, was observed with a unilateral and total cleft of the primary palate. Complications included a supernumerary tooth, hypoplasia and asymmetry of the face, and deformation of the eyeball and external auditory meatus. An accompanying pneumonia may have resulted from water flowing into the respiratory system due to imperfect closure of the nostril by the cleft. No other abnormalities were found.

Monkey performance: the development of bipedalism in trained Japanese monkeys

A series of studies collaborated by the Suo-sarumawashi (Japanese Monkey Performance) revealed the potential for bipedalism in Japanese monkey. The long-term training which aimed at stable upright posture introduced marked lumbar lordosis in monkeys. This feature is comparable to the humans' condition not only morphologically, but also functionally. The developed lordosis was retained even in normal pronograde posture of the monkeys. Bone remodeling in the postcranial skeleton also evidenced functional adaptations for stresses induced by sustained bipedalism. Postcrania of a trained monkey showed highly increased structural strength of bones and relatively large articular dimensions. Despite such adaptations, modifications of hindlimb bones were rather distinctive from humans' condition. This indicates a compromise between functional necessity and genetically determined anatomy. The hindlimb of Japanese monkey seemed to be more specialized for quadrupedal locomotion in many aspects compared to the vertebral column.

Immunophenotypic difference of keratin expression in normal mammary glandular cells from five different species

The immunohistochemical reactivity of human, monkey, shrew, rat and mouse normal mammary glands was examined using methacarn-fixed paraffin-embedded specimens and acetone-fixed frozen sections using the avidinbiotin-peroxidase method for cell phenotype comparison. Actin was visualized using anti-smooth muscle actin antibody and keratin expression was determined by employing 12 different monoclonal antibodies. All these antibodies cross-reacted specifically with the species examined. Basal (myoepithelial) cells from all species showed muscle-specific actin according to reactivity with HHF35 monoclonal antibody. Keratin expression showed significant phenotypic differences among species. In human and monkey, AEL-KS2, KL1, CK8.13, AE3 and 34BE12 stained luminal cells as well as basal cells. AE1, RPN1165, CK4.62, 35BE11, M20 and RPN1162 labeled only luminal cells whereas 312C8-1 preferentially bound to basal cells. In shrews, AEL-KS2, CK8.13 and AE3 reacted to both cell types, AE1 reacted only with luminal cells, and 35BE12 and 312C8-1 selectively stained basal cells. In rodents, AEL-KS2 reacted to both cell types, CK8.13, AE3, 34BE12 and 312C8-1 stained rat basal cells, and 34BE12 and 312C8-1 reacted to mouse basal cells. The data represents cytoskeletal differences among species.

Curvature of the lumbar spine as a consequence of mechanical necessities in Japanese macaques trained for bipedalism

If trained to walk bipedally at a juvenile age and over periods of some months or years, Japanese monkeys gradually acquire a pronounced lordosis of the lumbar spine. This lordosis persists even in the 'normal', pronograde posture of these animals. It is due to a relative increase of the ventral lengths of the vertebral bodies. This morphological change is clearly an adaptation to the mechanical necessities of the upright body posture. Our result is in complete accordance with the development of a lordosis in human children between 1 and 5 years, as described recently by others.

Three-dimensional analysis of the arterial pattern of the upper limbs in Lorisiformes (Prosimiae, Primates)

A study of the arterial patterns of the upper limbs in Lorisiformes (Prosimiae), especially those of the rete mirabile and their correlating arteries, was carried out by three-dimensional arteriographic analysis. The rete displayed at least two types of plexiform distribution: (1) a vascular bundle in Lorisidae, which consists of a division of the main artery into a principal trunk surrounded upwards by about 50 small arteries, and (2) a simple network pattern in Galagidae, which, at most, is composed of simple vascular networks of the nature of a few widely scattered anastomoses. The arterial patterns of the upper limb in Lorisiformes are basically the same, but the position of divergence and the number and size of the vessels in the rete differ. The arterial patterns of the upper limbs in Lorisiformes closely resemble the development of the vessels in the 21- to 23-mm stages of human embryonic growth. In this study, we observed some similarity in the patterns between the rete mirabile and the superficial brachial artery in man.